You are right that a lot of our heroin problem starts with prescribed opiates.
I do not think opiates ought to be less prescribed, instead doctors need to focus on HOW the opiates are used. After surgeries or other extreme pain situations, people should be allowed to get complete relief for their agonies. I had brain surgery 15 months ago and I was on morphine, then sent home with oxycodone. I never took very many of them and was done taking them by the 5th day or so.
First, patients should be talked to about how easy it would be to get addicted. They should take the least amount of pills they can a day to stop strong pain. They should only take pain meds to improve a level 5 or more pain during the first half of the day. If they’ve dealt with a 5 all day, have them take more in the evening or night, to approach complete relief.
Limit the number of pills given after surgery etc, and allow for quick refills if pain is severe still after 2-3 days.
Always push patients to try some time off the meds after 3 days. Have them try to see if they can get used to the pain (often in recovery pain naturally goes down by itself as they heal). Always stress that we want the patient to have pain relief but not to end up a junkie.
Remind the patient always that “really liking” the drug is a DANGER SIGN. Wanting to take “just one more tonight” without severe pain, wanting to take one “in case” pain arrives, are all signs of the start of getting hooked.
While I know we have an issue with opiate addiction, we shouldn’t deny the relief from pain that opiates give. We should never punish the innocent.
I am not against using them in cases where they are clearly warranted and I think your suggestions make perfect sense. Unfortunately, it is much faster for most doctors to simply write the script and send the patient out to play Russian roulette.
You clearly understand the wise way to use narcotics and the dangers involved. I am not generally a conspiracy theory kind of guy, but the lobbying power of the pharmaceutical industry on medical professionals is undeniably a big part of the problem. First do no harm.